Healthcare Provider Details

I. General information

NPI: 1568309383
Provider Name (Legal Business Name): TAMPA AUTISM DIAGNOSTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18952 N DALE MABRY HWY STE 102
LUTZ FL
33548-4916
US

IV. Provider business mailing address

PO BOX 47045
TAMPA FL
33646-0109
US

V. Phone/Fax

Practice location:
  • Phone: 656-206-1301
  • Fax: 656-213-0811
Mailing address:
  • Phone: 656-206-1301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MAURICE MORRIS
Title or Position: MANAGER
Credential:
Phone: 656-206-1301